Segal Nicolas, Polcz Valerie E, McKean Jordan A, Kariyawasam Vidhu, Carson Joshua S, Fahy Brenda G
Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA.
Department of Surgery, University of Florida College of Medicine, Gainesville, USA.
J Burn Care Res. 2021 Aug 4;42(4):832-835. doi: 10.1093/jbcr/irab016.
Burn patients with large burn surface area involvement are at increased risk of infection due to the presence of large wounds, multiple surgeries, prolonged intensive care unit admission, and immunosuppression. Pseudomonas aeruginosa is the most commonly isolated organism in this population. Even with frequent infections in the burn population, meningitis and encephalitis are rare, and ventriculitis is exceptional. We report the case of a 66-year-old woman who developed P. aeruginosa bacteremia during her hospital course, causing secondary meningoencephalitis with ventriculitis. She was admitted for partial- and full-thickness burns affecting the neck, chest, abdomen, upper medial arms, and bilateral anteromedial thighs for an estimated 20% total body surface area burn. She met sepsis criteria and broad-spectrum antimicrobial coverage was initiated. Magnetic resonance imaging of the brain, performed for altered mental status, revealed meningitis and ventriculitis. Cerebrospinal fluid analysis demonstrated findings consistent with bacterial meningitis, with cultures positive for P. aeruginosa. Serial neuroimaging with computerized tomography revealed new areas of ischemia concerning for septic emboli. In the presence of altered mental status and fever of unknown origin, workup should remain broad. Even in the presence of another source, it is important to keep an open mind for the rarer intracerebral infection as it requires different management, including urgent evaluation of antibiotic selection and dosing to ensure central nervous system penetration, and neurosurgical evaluation.
大面积烧伤患者由于存在大面积伤口、多次手术、长时间入住重症监护病房以及免疫抑制，感染风险增加。铜绿假单胞菌是该人群中最常分离出的病原体。即使烧伤人群中感染频繁，脑膜炎和脑炎也很罕见，脑室炎更是少见。我们报告了一例66岁女性病例，她在住院期间发生了铜绿假单胞菌血症，导致继发性脑膜脑炎并伴有脑室炎。她因颈部、胸部、腹部、上臂内侧和双侧大腿前内侧的部分和全层烧伤入院，估计烧伤总面积为20%。她符合脓毒症标准，开始了广谱抗菌治疗。因精神状态改变进行的脑部磁共振成像显示有脑膜炎和脑室炎。脑脊液分析结果与细菌性脑膜炎相符，培养结果显示铜绿假单胞菌阳性。计算机断层扫描的系列神经影像学检查发现了与脓毒性栓子有关的新的缺血区域。在存在精神状态改变和不明原因发热的情况下，检查范围应广泛。即使存在其他感染源，对于罕见的颅内感染也应保持开放的心态，因为其需要不同的治疗方法，包括紧急评估抗生素的选择和剂量以确保中枢神经系统的渗透，以及进行神经外科评估。
